Washington, D.C. – The Affordable Care Act has extraordinary potential to change the lives of millions of people. However, an analysis of a new survey by the Center for American Progress finds that connecting LGBT people with their new coverage options means carefully crafting messages that can overcome the awareness gap about these new options and address the skepticism and confusion that so many lesbian, gay, bisexual, and transgender, or LGBT, people feel about the law.
Implementing the Affordable Care Act requires efforts from a variety of stakeholders to ensure that the benefits of the law reach everyone who needs them. This is particularly the case for members of historically marginalized and disadvantaged populations, such as the LGBT population.
As anticipated, the data from the study indicate that LGBT people with incomes at or below 400 percent of the federal poverty level, or FPL—the segment of the population sampled for this study—stand to benefit significantly from provisions of the Affordable Care Act that expand and subsidize coverage for the uninsured. In particular, our study found a substantial percentage of respondents with very low incomes: 41 percent of the sample reported incomes at or below 139 percent of the FPL, with another 16 percent of the sample reporting incomes between 139 percent and 200 percent of the FPL. This is one-and-a-half times the rate reported in a sample from a similar survey conducted by Enroll America in December 2012, where 28 percent of respondents reported incomes at or below 139 percent of the FPL. These findings are consistent with earlier research demonstrating that LGB people, transgender people, and same-sex couples are more likely to live in poverty than their counterparts among the general population.
Consistent with previous research, one in three LGBT people in the survey was uninsured. Two-thirds of the uninsured had been without coverage for more than two years, and nearly half had never before shopped for health insurance. Of particular concern is that 48 percent of the uninsured live in southern states that are not expanding Medicaid and where state governments are actively opposing the implementation of the Affordable Care Act.
Nearly 4 in 10 uninsured respondents carried medical debt, and 44 percent of all respondents reported putting off medical care because they could not afford it. That number rises to 60 percent among the uninsured and 58 percent among those in the lowest income bracket (under 139 percent of the FPL).
“This research confirms what so many in the LGBT community have known for years: The health insurance system has not been working for LGBT people and our families,” said Laura E. Durso, Director of the LGBT Research and Communications Project at the Center for American Progress. “The result is that LGBT people have lacked access to the care they need. We know that the Affordable Care Act can significantly improve health care and coverage for the LGBT community, and effective messaging will be essential in connecting LGBT people across the country with coverage that meets their needs.”
When discussing coverage options, the Marketplaces and consumer-assistance personnel must be conversant in the specific concerns of LGBT people, particularly transgender people. Based on the findings, LGBT people have similar concerns to their non-LGBT counterparts—such as affordability and extent of coverage—but they also have unique needs related to family composition, experiences of discrimination, and concerns about coverage exclusions.
Read the report: LGBT Communities and the Affordable Care Act: Findings from a National Survey by Laura E. Durso, Kellan Baker, and Andrew Cray
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